REGIONAL HEALTH COMMAND-PACIFIC – Restrictions put in place to help control spread of the novel coronavirus have resulted in a large increase in telemedicine appointments, according to providers across the region.“Currently, for RHC-P on-island, all MTFs are using telemedicine in one form or another,” said Michelle Huml-VanZile, synchronous program director at Honolulu's Tripler Army Medical Center.According to the American Academy of Family Physicians, telemedicine is the practice of medicine using technology to deliver care at a distance. A provider in one location uses a video setup to deliver care to a patient at another site, likely their home.Regional Health Command-Pacific's large geographic area - covering the West Coast, Alaska, Hawaii, Japan, and Korea - means telemedicine's ability to bridge long distance gaps is a real advantage.“Virtual health is a great modality that is convenient for both the patient and provider,” Huml-VanZile said. “It reduces the need for ancillary staff at the provider site. VH can be used both in garrison and for operational use.”Since stay at home orders, school cancellations, and other measures designed to control the spread of COVID-19 began in mid-March, RHC-P military treatment facilities have seen a drastic increase in telemedicine appointments.Roughly 800 telemedicine appointments have been conducted in recent weeks, Huml-VanZile said; 74 percent of appointments in the Hawaii market were virtual this week.Another type of virtual medicine delivery, telehealth, differs from telemedicine by providing a broader scope of remote health care services. Telehealth provides mostly remote non-clinical services; telemedicine specifically covers remote clinical services.“At the lowest level, [telemedicine] is talking on the phone between a healthcare professional and patient,” said Col. Christine Kramer, the region’s nurse executive. “All MTFs are also doing virtual health, where the provider and patient can see one another.”Conducting virtual medical appointments gives providers a unique opportunity to interact with their patients; right now, remote appointments are often the only way for people to see their provider.“All RHC-P military treatment facilities are using telemedicine,” Kramer said. “All MTFs were using virtual health prior to the coronavirus pandemic, but the Defense Health Agency made more platforms available.”Those additional platforms include Skype and FaceTime, Kramer said, adding to Adobe Connect, Cisco Meeting Server, and Jabber, which were already in use for virtual health appointments. The variety of available digital platforms makes telemedicine even more accessible, the providers said.Patients may be concerned that the programs or software used to conduct appointments could be difficult to use. But, providers said, the additional platforms approved for use by DHA are widely available and commonly used.“It may take some individuals some time to get used to the technology on both the patient and provider side,” Kramer said, “but they will gain more confidence as they get used to the equipment.”Kramer said patient reaction to the use of telemedicine has been positive.“Usually the patients end up really liking it,” she said. “They enjoy the convenience and not having to travel to their appointment.”Lt. Col. Dolly Toney, a family nurse practitioner and chief of family medicine at the Brig. Gen. Crawford F. Sams Army Health Clinic at Camp Zama, Japan, said most types of appointment can be conducted via telemedicine, including primary and specialty care.“All family medicine appointments are scheduled as virtual appointments, except for certain obstetrics routine care and well-child appointments requiring immunizations, which require in-person visits,” Toney said. “A patient will be seen face-to-face on a case-by-case basis, as decided by the provider’s clinical judgment.”Toney said providers use an initial call to screen patients and rule out potential exposure to COVID-19 before having patients come in. Patients with questionable symptoms are received through the back door of the clinic.Medical procedures that require hands-on treatment aren’t suitable for telemedicine, providers said; those patients must still present in person at the treatment facilities.Providers interviewed said most patients will find telemedicine appointments convenient. Toney said it all starts with a phone call.“Patients make telemedicine appointments by calling the appointment line, booking on Tricare Online, or requesting an appointment via secure messaging,” Toney said. “Medical readiness refers periodic health assessments to the appointment line for telehealth. Follow-up appointments needing direct provider input are sometimes initiated by the provider.”There are several challenges to telemedicine, providers said, such as slow internet connections or technology issues. Despite the challenges, however, telemedicine and virtual health are seen as positive steps being taken during the pandemic.In one case, parents with an infant in the neonatal intensive care unit at Tripler were able to videoconference with their new baby and discuss the child’s health progress with staff.Telemedicine appointments also add another level of convenience, especially for service and family members in remote locations, Huml-VanZile said.“They take the pressure off families and service members,” she said. “They know they can be taken care of.”REGIONAL HEALTH COMMAND-PACIFIC APPOINTMENT LINES:Bassett Army Community Hospital: 907-361-4000Korea Central Appointment Line: DSN 737-2273Madigan Army Medical Center: 800-404-4506Brig. Gen. Crawford F. Sams Health Clinic: 046-407-4175; DSN 315-263-4175Tripler Army Medical Center/Desmond T. Doss Health Clinic: 888-683-2778